Prof. Nils Gunnar Wahlgren (Chair),Department of Clinical NeuroscienceKarolinska Institute, Sweden.Dr. Myzoon Ali (VISTA Coordinator)University of Glasgowwww.firstname.lastname@example.org
Data Contribution Form Clinical datasets will be lodged with the Robertson Centre for Biostatistics, University of Glasgow on behalf of VISTA.
Section 1.0 Clinical Dataset Information Using the checklist below, please ensure that your clinical datasets meet the eligibility criteria for VISTA-Plus.
Clinical diagnosis of stroke
Documented entry criteria
Documented consent or waiver of consent following local Institutional Review Board-approved procedure
Baseline assessment includes recording of a recognised stroke severity/impairment measure, eg. Barthel Index, NIHSS*, SSS,§ NEADL‡, mRS,o FIM† FAM•, Oxford, or similar
Outcome(s) assessed using one or more recognised measure(s)
Study was conducted within the last 15 years * National Institutes of Health Stroke Scale, § Scandinavian Stroke Scale‡ Nottingham Extended Acts of Daily Living† Functional Independence Measure• Functional Assessment Measure o Modified Rankin Scale
Please check the boxes corresponding to the format of your data.
SAS data sets
Microsoft Excel spreadsheets
Microsoft Access Database
Other (please state)
Section 2.0 Contribution Procedure Please provide contact details for the Principal Investigator(s) who will represent the trial on the VISTA-Plus Steering Committee:
Please detail the inclusion of relevant documents for your clinical dataset in the check-box below and attach these documents using the file transfer link that will be emailed separately.
All fields marked with * are essential
Please tick all files that are attached electronically
Raw Data* 1
Data Dictionary 2
Annotated CRF* 3
Ethics Approval* 5
Consent to hold/ collect original data 5
Section 3.0 Memorandum of Understanding Summary
I hereby acknowledge that I have read and understood the terms and conditions and consent to the contribution of the proposed trial/ registry to VISTA-Plus.
The raw datasets can be transferred using the University of Glasgow’s file transfer system. A separate link will be emailed to you following submission of this form.
Agree to Terms and Conditions
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